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. 2011 Sep;28(3):296-302.
doi: 10.1055/s-0031-1284456.

Anatomy and classification of gastrorenal and gastrocaval shunts

Saher S Sabri  1 , Wael E A Saad
Affiliations

Anatomy and classification of gastrorenal and gastrocaval shunts

Saher S Sabri et al. Semin Intervent Radiol. 2011 Sep.

Abstract

The gastric varices communicate with gastrorenal and gastrocaval shunts and are classified according to the pattern of venous inflow into three types, which differ in the number and location of the inflow veins. The gastric varices are also classified according to their venous drainage into four different types, reflecting the size and number of collateral veins communicating with the gastric varices and the gastrorenal/gastrocaval shunt. Lastly, the gastric varices are classified according to their appearance on balloon-occluded retrograde venography into five grades representing the degree of opacification of the gastric varices and the collateral veins. Understanding these anatomic classifications is crucial in planning endovascular obliteration of gastric varices.

Keywords: BRTO; Gastric varices; liver cirrhosis; portal hypertension; portosystemic shunt.

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Figures

Figure 1
Figure 1
Most common variceal anatomic variants. IVC, inferior vena cava; PV, portal vein, SV, splenic vein; SMV, superior mesenteric vein; LGV, left gastric vein; PGV: posterior gastric vein; SGV, short gastric vein; LRV, left renal vein. * indicates direct communication between gastric vein and gastrorenal or gastrocaval shunt.
Figure 2
Figure 2
Classification based on venous inflow . (A) Type 1 gastric varices are supplied by a single afferent gastric vein. This is the most common and simplest type to treat. (B) In type 2, the gastric varices are supplied by multiple afferent gastric veins; and (C) type 3, by single or multiple gastric veins with coexistent gastric veins that are directly contiguous with the shunt, but do not contribute to the varices.
Figure 3
Figure 3
Classification based on venous drainage. (A)Type A has a shunt with a single draining vein. (B) Type B has a shunt with multiple collateral draining veins. (C) Type C has both a gastrocaval and gastrorenal shunt. (D) Type D has multiple small draining veins and no shunt.
Figure 4
Figure 4
Classification based on degree of visualization of the gastric varices during balloon-occluded retrograde venography. (A) Grade 1. Gastric varices (arrow) are well opacified without evidence of collateral veins. (B) Grade 2. Collateral veins are small and few in number (white arrow). The gastric varices (black arrow) are well opacified (C). Grade 3. Collateral veins were medium to large (white arrows) and the contrast medium filled the gastric varices (black arrow) only partially. (D) Grade 4. Many large collateral veins (arrows), and the gastric varices are not opacified.
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